6 Recommendations for Overcoming No Surprises Act Hurdles

A workforce group penned a letter to HHS that highlights recommendations for meeting the legislation's deadlines.

The Workgroup for Electronic Data Interchange (WEDI) advisory group recently penned a letter outlining six ways HHS can work closely with standards development organizations and other healthcare partners to identify and pilot test appropriate No Surprises Act standards, harmonize them with existing and forthcoming standards and workflows, and more.

The No Surprises Act, which became effective January 1, contains provisions that protect patients from surprise medical billing and out-of-network emergency care costs not reimbursed by insurance.

Although considered a win for patients, the law (and its many nuances) have put a huge strain on organizations and their revenue cycle staff.

While WEDI strongly supports the overall goals of the No Surprises Act, the group says it has significant concerns regarding how the good faith estimate (GFE), GFE convening provider/facility provision, and advanced explanation of benefits (AEOB) requirements can be implemented by the healthcare industry.

The group says that with no established standards and automated workflows, providers and facilities will face challenges identifying who the convening provider/facility should be, who the appropriate co-providers/facilities should be, how to collect GFEs from these coproviders/facilities, and how to transmit GFEs to the patient’s health plan.

"Health plans will experience difficulties in collecting the GFE information necessary to produce the AEOB from providers and facilities and communicating to providers and facilities when GFE information is missing. All stakeholders will face hurdles meeting the legislation's deadlines to get GFEs and AEOBs to the patient," the group's letter states.

To address these challenges, WEDI has made the following six recommendations for HHS to consider:

1. Extend the enforcement discretion for the convening provider/facility provision of the Act.
2. Identify appropriate No Surprises Act GFE and AEOB data exchange standards and automated workflows for providers, facilities, and health plans.
3. Harmonize No Surprises Act GFE and AEOB data exchange standards with current and forthcoming administrative transactions.
4. Adopt No Surprises Act GFE and AEOB data exchange standards only after they have been pilot tested by appropriate industry stakeholders.
5. Employ a staged approach to meeting the data exchange requirements of the act until standards have been fully adopted by the industry.
6. Work with industry partners to educate patients and industry stakeholders on the No Surprises Act opportunities and requirements.

The group says it looks forward to a continued partnership with the federal government and offering assistance in the development and implementation of an appropriate No Surprises Act pathway.